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Sudoł-Szopińska I, Lanckoroński M, Diekhoff T, Ključevšek D, Del Grande F, Doria A. Update on MRI in Rheumatic Diseases. Radiol Clin North Am 2024; 62:821-836. [PMID: 39059974 DOI: 10.1016/j.rcl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
Over the past decade, MRI has significantly advanced the diagnosis of rheumatic disease in both adults and juveniles. In this article, the authors present an update on MRI applications in rheumatology, based on a review of the most recent publications. New developments in adults related to, among others, axial spondyloarthritis, peripheral arthritis, and the whole body-MRI (WB-MRI) are presented. In juveniles, this update addresses the latest advancements in diagnostic MRI of peripheral joints, followed by MRI of the axial skeleton and implementation of the WB-MRI for the screening of inflammation. The authors also discuss topics of interest concerning contrast-enhanced MRI examinations in children.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.
| | - Michał Lanckoroński
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Torsten Diekhoff
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Damjana Ključevšek
- Department of Radiology, University Children's Hospital Ljubljana, Slovenia
| | - Filippo Del Grande
- Clinica di Radiologia EOC, Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), Ospedale Civico via Tesserete 47, Lugano-Ti 6900, Switzerland
| | - Andrea Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children; Department of Medical Imaging, University of Toronto, Toronto, Canada
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Hemke R, Herregods N, Jaremko JL, Maas M. Imaging of Juvenile Idiopathic Arthritis. Radiol Clin North Am 2024; 62:889-902. [PMID: 39059979 DOI: 10.1016/j.rcl.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
MRI, ultrasound, and conventional radiography each play distinct roles in the evaluation of juvenile idiopathic arthritis (JIA), with MRI being the preferred imaging modality of choice for assessing both inflammatory and destructive changes. These various imaging modalities provide valuable insights into JIA in pediatric patients. However, challenges persist in terms of achieving precision, ensuring validity, and distinguishing between pathologic findings and normal anatomic variations. Establishing normal reference values and implementing scoring systems can aid in the precise evaluation of disease activity and provide information to assist treatment decisions for children with JIA. Ongoing advancements in imaging techniques and standardization initiatives aim to bolster the accuracy of JIA diagnosis and assessment, ultimately leading to enhanced patient care and treatment outcomes.
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Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam 1105AZ, The Netherlands.
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam 1105AZ, The Netherlands
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Handa A, Bedoya MA, Iwasaka-Neder J, Johnston PR, Lo MS, Bixby SD. Measuring synovial thickness on knee MRI in pediatric patients with arthritis: is contrast necessary? Pediatr Radiol 2024; 54:988-1000. [PMID: 38641735 DOI: 10.1007/s00247-024-05929-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The use of contrast-enhanced imaging has long been standard for magnetic resonance imaging (MRI) assessments of synovitis in juvenile idiopathic arthritis (JIA). However, advancements in MRI technology have allowed for reliable identification of synovium without contrast. OBJECTIVE To assess the equivalence of unenhanced MRI with contrast-enhanced MRI in evaluating synovial thickness. MATERIALS AND METHODS This is an institutional review board approved, retrospective study performed in a tertiary children's hospital. Pediatric JIA patients under 21 years old were included who underwent knee MRI scans (1.5 T or 3 T) without and with contrast between January 2012 and January 2022. Two radiologists independently measured synovial thickness at 6 knee sites on contrast-enhanced and unenhanced sequences. Numerical measurements and ordinal scores based on juvenile idiopathic arthritis magnetic resonance imaging scoring (JAMRIS) system were recorded, and tests of equivalence were conducted, as well as between-reader and within-reader reliability by concordance correlation coefficient (CCC). All tests were considered significant at the 5% level. RESULTS A total of 38 studies from 35 patients (25 females, median age 14 years; interquartile range 7 to 15.7) were included. Equivalence was demonstrated at each of the 6 sites for both continuous measurements (P-values < 0.05) and ordinal scores (P-values < 0.05) based on the average over readers. Within-reader reliability was moderate to high (CCC 0.50-0.89), except for the cruciate ligaments site. Averaged over the 6 sites, reliability between readers was low for unenhanced (CCC 0.47, with 95% CI: [0.41, 0.53]) and moderate for contrast-enhanced (CCC 0.64, with 95% CI: [0.59, 0.69]) sequences. CONCLUSION Unenhanced knee MRI is equivalent to contrast-enhanced MRI in assessment of synovial thickness using conventional MRI sequences. Contrast material helped improve inter-reader reliability.
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Affiliation(s)
- Atsuhiko Handa
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - M Alejandra Bedoya
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Jade Iwasaka-Neder
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Patrick R Johnston
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Mindy S Lo
- Department of Immunology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Sarah D Bixby
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
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Vega-Fernandez P, Rogers K, Sproles A, Thornton S, Huggins J, Lovell DJ, Cassedy A, Meyers AB, Ting TV. Diagnostic Accuracy Study of the Pediatric-Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2024; 76:251-258. [PMID: 37587869 PMCID: PMC10841426 DOI: 10.1002/acr.25218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA). METHODS Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode. In addition to MSUS, a subset of participants also received magnetic resonance imaging (MRI) of the knee, which was scored according to the combined Juvenile Arthritis MRI Scoring (JAMRIS) system. Spearman's correlations (rs ) were used to calculate associations between variables. Test characteristics of the PAUSS-knee were calculated with MRI as the reference standard. Inflammatory biomarkers were assessed in synovial fluid from involved knees. RESULTS Eighty children with JIA contributed 112 MSUSs and 25 MRIs of the knee. Of the knees, 41% (n = 46) had clinical evidence of arthritis. The B-mode PAUSS-knee score moderately correlated with clinically determined arthritis (rs = 0.54, P < 0.001) and strongly correlated with the JAMRIS score (rs = 0.75, P < 0.001). Compared with MRI, the area under the curve for the B-mode PAUSS-knee was 0.92. For a cutoff of >1, the B-mode PAUSS-knee had a sensitivity of 83% and specificity of 82%. Biomarker analysis indicates that interleukin-2R levels correlate with PAUSS score. CONCLUSION Our data indicate that the PAUSS-knee has excellent accuracy for the diagnosis of arthritis when compared with MRI. The PAUSS-knee has the potential to effectively inform JIA medical decision-making in real time.
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Affiliation(s)
- Patricia Vega-Fernandez
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly Rogers
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Alyssa Sproles
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sherry Thornton
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Huggins
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J. Lovell
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Cassedy
- Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, USA
| | - Arthur B Meyers
- Department of Radiology, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Division of Radiology, Cincinnati, OH, USA
| | - Tracy V Ting
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Navallas M, Tolend M, Otobo TM, Panwar J, Clemente EJI, Hemke R, van Rossum MA, Doria AS. Developing standards for MRI evaluation of joints in children with juvenile idiopathic arthritis utilizing the temporomandibular joint as a model. Jpn J Radiol 2024; 42:56-68. [PMID: 37626169 DOI: 10.1007/s11604-023-01479-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023]
Abstract
The treatment of a patient with juvenile idiopathic arthritis (JIA) is best monitored with standardized and validated tools to measure joint changes over time. Treatment approaches are best indicated if the clinicians are aware of the structural status of the joint at a given time, especially in anatomically deep joints for which clinical assessment is limited. Magnetic resonance imaging (MRI) is of utmost importance for assessment of deep joints and extra-articular soft tissue of the entire body for which ultrasound may be suboptimal. Because the distinction between pathologic and physiologic joint changes on MRI is key for proper diagnosis and treatment of patients with arthropathies, a comprehensive standardized approach is needed to effectively measure outcomes of growing joints of children with JIA. Such an approach is essential for both clinical assessment and to conduct clinical trials in patients with JIA treated in different centers around the world. To meet this need, several international imaging collaborative research groups have been developing MRI scales over the past years, including the MRI in JIA (JAMRI) special interest group within the Outcome Measures in Rheumatology (OMERACT) research network. This manuscript reviews the efforts of the OMERACT JAMRI working group to generate and validate pediatric MRI scoring systems for different joints in children with JIA that can have ubiquitous utilization anywhere in the world. In particular, it describes the different steps of development and validation of an MRI scale using the TMJ as a model.
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Affiliation(s)
- Maria Navallas
- Department of Diagnostic Imaging. Hospital 12 de Octubre, Madrid, Spain
| | - Mirkamal Tolend
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Tarimobo M Otobo
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Jyoti Panwar
- Department of Medical Imaging, The Tweed Hospital, Lumus Imaging, Tweed Heads, NSW, Australia
| | - Emilio J Inarejos Clemente
- Department of Diagnostic Imaging. Sant Joan de Deu Barcelona Children Hospital, University of Barcelona, Barcelona, Spain
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marion A van Rossum
- Department of Pediatrics, Emma Children's Hospital Amsterdam University Medical Centers and Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, The Netherlands
| | - Andrea S Doria
- Department of Diagnostic Imaging, Research Institute, The Hospital for Sick Children, and Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Tanturri de Horatio L, Shelmerdine SC, d'Angelo P, Di Paolo PL, Magni-Manzoni S, Malattia C, Damasio MB, Tomà P, Avenarius D, Rosendahl K. A novel magnetic resonance imaging scoring system for active and chronic changes in children and adolescents with juvenile idiopathic arthritis of the hip. Pediatr Radiol 2023; 53:426-437. [PMID: 36149477 PMCID: PMC9968695 DOI: 10.1007/s00247-022-05502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hip involvement predicts severe disease in juvenile idiopathic arthritis (JIA) and is accurately assessed by MRI. However, a child-specific hip MRI scoring system has not been validated. OBJECTIVE To test the intra- and interobserver agreement of several MRI markers for active and chronic hip changes in children and young adults with JIA and to examine the precision of measurements commonly used for the assessment of growth abnormalities. MATERIALS AND METHODS Hip MRIs from 60 consecutive children, adolescents and young adults with JIA were scored independently by two sets of radiologists. One set scored the same MRIs twice. Features of active and chronic changes, growth abnormalities and secondary post-inflammatory changes were scored. We used kappa statistics to analyze inter- and intraobserver agreement for categorical variables and a Bland-Altman approach to test the precision of continuous variables. RESULTS Among active changes, there was good intra- and interobserver agreement for grading overall inflammation (kappa 0.6-0.7). Synovial enhancement showed a good intraobserver agreement (kappa 0.7-0.8), while the interobserver agreement was moderate (kappa 0.4-0.5). Regarding acetabular erosions on a 0-3 scale, the intraobserver agreement was 0.6 for the right hip and 0.7 for the left hip, while the interobserver agreement was 0.6 for both hips. Measurements of joint space width, caput-collum-diaphyseal angle, femoral neck-head length, femoral width and trochanteric distance were imprecise. CONCLUSION We identified a set of MRI markers for active and chronic changes in JIA and suggest that the more robust markers be included in future studies addressing clinical validity and long-term patient outcomes.
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Affiliation(s)
- Laura Tanturri de Horatio
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy.
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway.
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Bloomsbury, London, UK
- Department of Radiology, St. George's Hospital, London, UK
| | - Paola d'Angelo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Pier Luigi Di Paolo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | | | - Clara Malattia
- Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Derk Avenarius
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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Juvenile idiopathic arthritis of the knee: is contrast needed to score disease activity when using an augmented MRI protocol comprising PD-weighted sequences? Eur Radiol 2022; 33:3775-3784. [PMID: 36472701 PMCID: PMC10121492 DOI: 10.1007/s00330-022-09292-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022]
Abstract
Abstract
Objective
To compare unenhanced versus enhanced knee joint magnetic resonance imaging (MRI) to assess disease activity of juvenile idiopathic arthritis (JIA).
Methods
Fifty-three knee joint MRI examinations were performed on a 3-Tesla system in 27 patients (age: 11.40 ± 3.61 years; 21 females, 6 males). MRI protocols comprised PD-weighted sequences in addition to the widely used standard protocol. JIA subgroups comprised oligoarticular arthritis (n = 16), extended oligoarthritis (n = 6), rheumatoid factor-negative polyarticular arthritis (n = 3), enthesitis-related arthritis (n = 1), and psoriatic arthritis (n = 1). MR images were retrospectively analyzed by 3 experienced radiologists in two readings, using JAMRIS (juvenile arthritis MRI scoring) system and a modified IPSG (international prophylaxis study group) classification. In the first reading session, only unenhanced MR images were evaluated. In a second reading session, all images before and after contrast medium application were included. In order to avoid bias, an interval of at least 2 weeks was set between the two readings. The clinical JADAS10 (juvenile arthritis disease activity score) was calculated including clinical assessment and laboratory workup and correlated with MRI scores. Statistical analysis comprised Pearson’s correlation for correlating two scoring results of unenhanced and the enhanced MRI, intra-class correlation coefficient (ICC) for inter- and intra-reader agreement. Diagnostic accuracy was calculated using ROC (receiver operating characteristics) curve analysis.
Results
Inter-reader agreement determined by ICC for unenhanced and enhanced MRI scores for IPSG was moderate (0.65, 95% CI 0.51–0.76, and 0.62, 95% CI 0.48–0.75) and high for JAMRIS (0.83, 95% CI 0.75–0.89, and 0.82, 95% CI 0.74–0.89). Intra-reader agreement was good to very good for JAMRIS (0.85 95% CI 0.81–0.88, 0.87 95% CI 0.83–0.89 and 0.96 95% CI 0.92–0.98) and IPSG (0.76 95% CI 0.62–0.86, 0.86 95% CI 0.77–0.92 and 0.92 95% CI 0.86–0.96). Scores of unenhanced MRI correlated with contrast-enhanced MRI: JAMRIS (r = 0.97, R2 = 0.93, p < 0.01), modified IPSG (r = 0.95, R2 = 0.91, p < 0.01). When using JADAS10 as a reference standard, moderate accuracy for both unenhanced and enhanced MRI scores was noted: JAMRIS (AUC = 0.68, 95% CI 0.51–0.85, and AUC = 0.66, 95% 0.49–0.82), IPSG score (AUC = 0.68, 95% 0.50–0.86, and AUC = 0.61, 95% 0.41–0.81).
Conclusions
Our results suggest that contrast agent application could be omitted in JIA patients with an augmented knee MRI protocol comprising PD-weighted sequence.
Key Points
• Unenhanced MRI can detect disease activity of the knee joint in patients with JIA with equally high accuracy compared to contrast-enhanced MRI.
• The intra- and inter-reader agreement was high for unenhanced and enhanced MRI JAMRIS scores, which indicate relatively good applicability of the scoring system, even for less experienced readers.
• When using the clinical JADAS10 as a reference standard for the detection of disease activity, moderate accuracy for both unenhanced and enhanced MRI scores, both JAMRIS and IPSG, was noted, which might be caused by the fact that the majority of patients had either no or minimal clinical disease activity.
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Sudoł-Szopińska I, Herregods N, Doria AS, Taljanovic MS, Gietka P, Tzaribachev N, Klauser AS. Advances in Musculoskeletal Imaging in Juvenile Idiopathic Arthritis. Biomedicines 2022; 10:biomedicines10102417. [PMID: 36289680 PMCID: PMC9598961 DOI: 10.3390/biomedicines10102417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past decade, imaging of inflammatory arthritis in juvenile arthropathies has significantly advanced due to technological improvements in the imaging modalities and elaboration of imaging recommendations and protocols through systematic international collaboration. This review presents the latest developments in ultrasound (US) and magnetic resonance imaging (MRI) of the peripheral and axial joints in juvenile idiopathic arthritis. In the field of US, the ultra-wideband and ultra-high-frequency transducers provide outstanding spatial resolution. The more sensitive Doppler options further improve the assessment and quantification of the vascularization of inflamed tissues, and shear wave elastography enables the diagnosis of tissue stiffness. Concerning MRI, substantial progress has been achieved due to technological improvements in combination with the development of semiquantitative scoring systems for the assessment of inflammation and the introduction of new definitions addressing the pediatric population. New solutions, such as superb microflow imaging, shear wave elastography, volume-interpolated breath-hold examination, and MRI-based synthetic computed tomography open new diagnostic possibilities and, at the same time, pose new challenges in terms of clinical applications and the interpretation of findings.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
- Correspondence:
| | - Nele Herregods
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Andrea S. Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, University Avenue, Toronto, ON M5G 1X8, Canada
| | - Mihra S. Taljanovic
- Department of Medical Imaging and Orthopaedic Surgery, University of Arizona, Tucson, AZ 85719, USA
- Department of Radiology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Piotr Gietka
- Clinic of Paediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland
| | - Nikolay Tzaribachev
- Pediatric Rheumatology Research Institute, Achtern Dieck 7, 24576 Bad Bramstedt, Germany
| | - Andrea Sabine Klauser
- Rheumatology and Sports Imaging, Department of Radiology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Jana M, Mittal D, Bagri N, Yadav R, Parihar V, Bagri NK. Role of Imaging in Childhood Arthritis. J Clin Rheumatol 2022; 28:e539-e544. [PMID: 33843776 DOI: 10.1097/rhu.0000000000001735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Imaging plays a pivotal role in the management of various childhood arthritis. Conventional radiography is the most commonly ordered imaging modality for the evaluation of arthritis. Owing to their higher sensitivity for detecting synovitis, magnetic resonance imaging and ultrasonography are increasingly being used to guide clinical management of various forms of arthritis, especially juvenile idiopathic arthritis. Magnetic resonance imaging is a preferred modality for evaluating more complex sites such as the sacroiliac joint. In this review, we have discussed the rational use and the characteristic imaging features of common childhood arthritis.
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Affiliation(s)
- Manisha Jana
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Disha Mittal
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Neha Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Richa Yadav
- From the Department of Radiodiagnosis, All India Institute of Medical Sciences (AIIMS)
| | - Vivek Parihar
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
| | - Narendra Kumar Bagri
- Division of Pediatric Rheumatology, Department of Pediatrics, AIIMS, New Delhi, India
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Zadig P, von Brandis E, d’Angelo P, de Horatio LT, Ording-Müller LS, Rosendahl K, Avenarius D. Whole-body MRI in children aged 6-18 years. Reliability of identifying and grading high signal intensity changes within bone marrow. Pediatr Radiol 2022; 52:1272-1282. [PMID: 35445816 PMCID: PMC9192437 DOI: 10.1007/s00247-022-05312-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Whole-body magnetic resonance imaging (MRI) is increasingly being used in children, however, to date there are no studies addressing the reliability of the findings. OBJECTIVE To examine intra- and interobserver reliability of a scoring system for assessment of high signal areas within the bone marrow, as visualized on T2-weighted, fat-saturated images. MATERIALS AND METHODS Ninety-six whole-body MRIs (1.5 T) in 78 healthy volunteers (mean age: 11.5 years) and 18 children with chronic nonbacterial osteomyelitis (mean age: 12.4 years) were included. Coronal water-only Dixon T2-weighted images were used to score the left lower extremity/pelvis for high signal intensity areas, intensity (0-2 scale), extension (0-4 scale) and shape and contour in a blinded fashion by two pairs of radiologists. RESULTS For the pelvis, grading of bone marrow signal showed moderate to good intra- and interobserver agreement with kappa values of 0.51-0.94 and 0.41-0.87, respectively. Corresponding figures for the femur were 0.61-0.68 within and 0.32-0.61 between observers, and for the tibia 0.60-0.72 and 0.51-0.73. Agreement for assessing extension was moderate to good both within and between observers for the pelvis (k = 0.52-0.85 and 0.35-0.80), for the femur (0.52-0.67 and 0.51-0.60) and for the tibia (k = 0.59-0.69 and 0.47-0.63) except for the femur metaphysis/diaphysis, with interobserver kappa values of 0.29-0.30. Scoring of shape was moderate to good within observers, but in general poorer between observers, with kappa values of 0.40-0.73 and 0.18-0.69, respectively. For contour, the corresponding figures were 0.35-0.62 and 0.09-0.54, respectively. CONCLUSION MRI grading of intensity and extension of high signal intensity areas within the bone marrow of pelvis and lower limb performs well and thus can be used interchangeably by different observers, while assessment of shape and contour is reliable for the same observer but is less reliable between observers. This should be considered when performing clinical trials.
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Affiliation(s)
- Pia Zadig
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway. .,Department of Clinical Medicine, Uit, The Arctic University of Norway, Tromsø, Norway.
| | - Elisabeth von Brandis
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway ,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Paola d’Angelo
- Department of Pediatric Radiology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Laura Tanturri de Horatio
- Department of Clinical Medicine, Uit, The Arctic University of Norway, Tromsø, Norway ,Department of Pediatric Radiology, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Karen Rosendahl
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway ,Department of Clinical Medicine, Uit, The Arctic University of Norway, Tromsø, Norway
| | - Derk Avenarius
- Department of Radiology, University Hospital of North-Norway, Tromsø, Norway ,Department of Clinical Medicine, Uit, The Arctic University of Norway, Tromsø, Norway
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11
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Automated segmentation of magnetic resonance bone marrow signal: a feasibility study. Pediatr Radiol 2022; 52:1104-1114. [PMID: 35107593 PMCID: PMC9107442 DOI: 10.1007/s00247-021-05270-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/12/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Manual assessment of bone marrow signal is time-consuming and requires meticulous standardisation to secure adequate precision of findings. OBJECTIVE We examined the feasibility of using deep learning for automated segmentation of bone marrow signal in children and adolescents. MATERIALS AND METHODS We selected knee images from 95 whole-body MRI examinations of healthy individuals and of children with chronic non-bacterial osteomyelitis, ages 6-18 years, in a longitudinal prospective multi-centre study cohort. Bone marrow signal on T2-weighted Dixon water-only images was divided into three color-coded intensity-levels: 1 = slightly increased; 2 = mildly increased; 3 = moderately to highly increased, up to fluid-like signal. We trained a convolutional neural network on 85 examinations to perform bone marrow segmentation. Four readers manually segmented a test set of 10 examinations and calculated ground truth using simultaneous truth and performance level estimation (STAPLE). We evaluated model and rater performance through Dice similarity coefficient and in consensus. RESULTS Consensus score of model performance showed acceptable results for all but one examination. Model performance and reader agreement had highest scores for level-1 signal (median Dice 0.68) and lowest scores for level-3 signal (median Dice 0.40), particularly in examinations where this signal was sparse. CONCLUSION It is feasible to develop a deep-learning-based model for automated segmentation of bone marrow signal in children and adolescents. Our model performed poorest for the highest signal intensity in examinations where this signal was sparse. Further improvement requires training on larger and more balanced datasets and validation against ground truth, which should be established by radiologists from several institutions in consensus.
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12
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Magnetic resonance imaging of the knee joint in juvenile idiopathic arthritis. Reumatologia 2021; 58:416-423. [PMID: 33456085 PMCID: PMC7792535 DOI: 10.5114/reum.2020.102007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for a group of diseases in children younger than 16 years old lasting six weeks or longer. Synovitis may lead to destructive and irreversible joint changes with subsequent functional impairment. Prompt diagnosis is essential to prevent permanent joint damage and preserve joint functionality. In the course of JIA both the axial and peripheral skeleton may be involved in the inflammatory process, but the knee joint is most frequently affected. New drugs and treatment protocols have forced the need for diagnosis at the earliest possible stage. Magnetic resonance imaging (MRI) allows early detection of lesions and constitutes a superior diagnostic imaging method. Synovitis, tenosynovitis, enthesitis, bursitis, osteitis, cartilage loss, bone cysts, and erosions are lesions diagnosed in JIA, and they can be precisely imaged in MRI. This article aims to present MRI inflammatory features of the knee in children with JIA based on the literature.
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13
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Hemke R, Herregods N, Jaremko JL, Åström G, Avenarius D, Becce F, Bielecki DK, Boesen M, Dalili D, Giraudo C, Hermann KG, Humphries P, Isaac A, Jurik AG, Klauser AS, Kvist O, Laloo F, Maas M, Mester A, Oei E, Offiah AC, Omoumi P, Papakonstantinou O, Plagou A, Shelmerdine S, Simoni P, Sudoł-Szopińska I, Tanturri de Horatio L, Teh J, Jans L, Rosendahl K. Imaging assessment of children presenting with suspected or known juvenile idiopathic arthritis: ESSR-ESPR points to consider. Eur Radiol 2020; 30:5237-5249. [PMID: 32399709 PMCID: PMC7476913 DOI: 10.1007/s00330-020-06807-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/08/2020] [Accepted: 03/12/2020] [Indexed: 12/17/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatic disease. It represents a group of heterogenous inflammatory disorders with unknown origin and is a diagnosis of exclusion in which imaging plays an important role. JIA is defined as arthritis of one or more joints that begins before the age of 16 years, persists for more than 6 weeks and is of unknown aetiology and pathophysiology. The clinical goal is early suppression of inflammation to prevent irreversible joint damage which has shifted the emphasis from detecting established joint damage to proactively detecting inflammatory change. This drives the need for imaging techniques that are more sensitive than conventional radiography in the evaluation of inflammatory processes as well as early osteochondral change. Physical examination has limited reliability, even if performed by an experienced clinician, emphasising the importance of imaging to aid in clinical decision-making. On behalf of the European Society of Musculoskeletal Radiology (ESSR) arthritis subcommittee and the European Society of Paediatric Radiology (ESPR) musculoskeletal imaging taskforce, based on literature review and/or expert opinion, we discuss paediatric-specific imaging characteristics of the most commonly involved, in literature best documented and clinically important joints in JIA, namely the temporomandibular joints (TMJs), spine, sacroiliac (SI) joints, wrists, hips and knees, followed by a clinically applicable point to consider for each joint. We will also touch upon controversies in the current literature that remain to be resolved with ongoing research. KEY POINTS: • Juvenile idiopathic arthritis (JIA) is the most common chronic paediatric rheumatic disease and, in JIA imaging, is increasingly important to aid in clinical decision-making. • Conventional radiographs have a lower sensitivity and specificity for detection of disease activity and early destructive change, as compared to MRI or ultrasound. Nonetheless, radiography remains important, particularly in narrowing the differential diagnosis and evaluating growth disturbances. • Mainly in peripheral joints, ultrasound can be helpful for assessment of inflammation and guiding joint injections. In JIA, MRI is the most validated technique. MRI should be considered as the modality of choice to assess the axial skeleton or where the clinical presentation overlaps with JIA.
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Affiliation(s)
- Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Nele Herregods
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gunnar Åström
- Department of Radiology, Uppsala University, Uppsala, Sweden
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Dennis K Bielecki
- Department of Diagnostic Imaging, Kings College Hospital, London, UK
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Danoob Dalili
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Chiara Giraudo
- Radiology Institute, Department of Medicine - DIMED, Padova University, Padua, Italy
| | - Kay-Geert Hermann
- Department of Radiology, University Hospital Charité, Berlin, Germany
| | - Paul Humphries
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Amanda Isaac
- Department of Radiology, Guy's & St Thomas Hospitals, London, UK
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Andrea S Klauser
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ola Kvist
- Department of Paediatric Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frederiek Laloo
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Adam Mester
- Department of Radiology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Edwin Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center (Erasmus MC), Rotterdam, The Netherlands
| | - Amaka C Offiah
- Academic Unit of Child Health, University of Sheffield, Western Bank, Sheffield, UK
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | - Paolo Simoni
- Department of Radiology, Reine Fabiola Children's University Hospital of Bruxelles, University of Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation and Department of Medical Imaging, Medical University of Warsaw, Warsaw, Poland
| | | | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Lennart Jans
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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14
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Barendregt AM, van Gulik EC, Groot PFC, Dolman KM, van den Berg JM, Nassar-Sheikh Rashid A, Schonenberg-Meinema D, Lavini C, Rosendahl K, Hemke R, Kuijpers TW, Maas M, Nusman CM. Prolonged time between intravenous contrast administration and image acquisition results in increased synovial thickness at magnetic resonance imaging in patients with juvenile idiopathic arthritis. Pediatr Radiol 2019; 49:638-645. [PMID: 30707259 DOI: 10.1007/s00247-018-04332-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/07/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Post-contrast synovial thickness measurement is necessary for scoring disease activity in juvenile idiopathic arthritis (JIA). However, the timing of post-contrast sequences varies widely among institutions. This variation in timing could influence thickness measurements. OBJECTIVE To measure thickness of the synovial membrane on early and late post-contrast knee magnetic resonance (MR) images of patients with JIA. MATERIALS AND METHODS Dynamic contrast-enhanced T1-weighted knee MR images of 53 children with JIA with current or past knee arthritis were used to study synovial thickness at time point 1 (about 1 min) and time point 2 (about 5 min after contrast administration). Two experienced readers, who were blinded for the time point, independently measured synovial thickness at a predefined, marked location in the patellofemoral compartment on randomized images. Synovial thickness at the two time points was compared using the Wilcoxon signed rank test. Repeatibility of the synovial thickness measurements was studied using intraclass correlation coefficients and Bland-Altman plots. RESULTS Median synovial thickness of the 53 patients (median age: 13.5 years, 59% female) increased with prolonged post-contrast interval with a synovial thickness of 1.4 mm at time point 1 and a synovial thickness of 1.5 mm at time point 2 (P<0.001). Repeated synovial thickness measurements showed an intraclass correlation coefficient (ICC) of 0.75, P<0.05 for time point 1 and an ICC of 0.91, P<0.05 for time point 2. CONCLUSION Post-contrast synovial membrane thickness measurements are time-dependent. Therefore, standardization of post-contrast image acquisition timing is important to achieve consistent grading of synovial inflammation.
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Affiliation(s)
- Anouk M Barendregt
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands. .,Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - E Charlotte van Gulik
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Paul F C Groot
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Koert M Dolman
- Department of Pediatric Rheumatology, Reade, Dr. Jan van Breemenstraat 2, Amsterdam, the Netherlands.,Department of Pediatric Rheumatology, Onze Lieve Vrouwe Gasthuis West, Jan Tooropstraat, 164, Amsterdam, the Netherlands.,Department of Pediatric Rheumatology, Onze Lieve Vrouwe Gasthuis Oost, Oosterpark 9, Amsterdam, the Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amara Nassar-Sheikh Rashid
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cristina Lavini
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Section of Pediatric Radiology, Haukeland University Hospital, Jonas Lies Vei 65, PB 1400, 5021, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Jonas Lies Vei 87, N-5021, Bergen, Norway
| | - Robert Hemke
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Charlotte M Nusman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Disease, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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15
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Collado P, Windschall D, Vojinovic J, Magni-Manzoni S, Balint P, Bruyn GAW, Hernandez-Diaz C, Nieto JC, Ravagnani V, Tzaribachev N, Iagnocco A, D’Agostino MA, Naredo E. Amendment of the OMERACT ultrasound definitions of joints' features in healthy children when using the DOPPLER technique. Pediatr Rheumatol Online J 2018; 16:23. [PMID: 29631610 PMCID: PMC5892017 DOI: 10.1186/s12969-018-0240-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/27/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recently preliminary ultrasonography (US) definitions, in B mode, for normal components of pediatric joints have been developed by the OMERACT US group. The aim of the current study was to include Doppler findings in the evaluation and definition of normal joint features that can be visualized in healthy children at different age groups. METHODS A multistep approach was used. Firstly, new additional definitions of joint components were proposed during an expert meeting. In the second step, these definitions, along with the preliminary B-mode-US definitions, were tested for feasibility in an exercise in healthy children at different age groups. In the last step, a larger panel of US experts were invited to join a web-based consensus process in order to approve the developed definitions using the Delphi methodology. A Likert scale of 1-5 was used to assess agreement. RESULTS Physiological vascularity and fat pad tissue were identified and tested as two additional joint components in healthy children. Since physiological vascularity changes over the time in the growing skeleton, the final definition of Doppler findings comprised separate statements instead of a single full definition. A total of seven statements was developed and included in a written Delphi questionnaire to define and validate the new components. The final definitions for fat pad and physiological vascularity agreed by the group of experts reached 92.9% and 100% agreement respectively in a web survey. CONCLUSION The inclusion of these two additional joints components which are linked to detection of Doppler signal in pediatric healthy joints will improve the identification of abnormalities in children with joint pathologies.
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Affiliation(s)
- P. Collado
- 0000 0001 0635 4617grid.411361.0Hospital Universitario Severo Ochoa., Madrid, Spain
| | - D. Windschall
- Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany
| | - J. Vojinovic
- 0000 0001 0942 1176grid.11374.30Department of Pediatrics, Clinical Center, Faculty of Medicine, University of Nis, Nis, Serbia
| | - S. Magni-Manzoni
- 0000 0001 0727 6809grid.414125.7Rheumatology Division, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - P. Balint
- 0000 0004 0637 0256grid.419642.c3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - G. A. W. Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - C. Hernandez-Diaz
- 0000 0004 0633 2911grid.419223.fInstituto Nacional de Rehabilitación, Mexico City, Mexico
| | - J. C. Nieto
- 0000 0001 0277 7938grid.410526.4Department of Rheumatology, Hospital Universitario Gregorio Marañon, Madrid, Spain
| | - V. Ravagnani
- 0000 0004 0493 6690grid.413174.4Department of Internal Medicine, ASST Mantova, C. Poma Hospital, Mantova, Italy
| | - N. Tzaribachev
- Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
| | - A. Iagnocco
- grid.7841.aRheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - M. A. D’Agostino
- 0000 0001 2323 0229grid.12832.3aRheumatology Department, Hôspital Ambroise Paré, Boulogne Billancourt; INSERM U1173, Laboratoire d’Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Yvelines, France
| | - E. Naredo
- grid.419651.eDepartment of Rheumatology, Hospital Universitario Fundación Jimenez Díaz and Autonoma University, Madrid, Spain
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16
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Nusman CM, de Horatio LT, Hemke R, van Gulik EC, Ording Müller LS, Malattia C, Avenarius D, Toma P, Roth J, Tzaribachev N, Magni-Manzoni S, Maas M, Doria AS, Rosendahl K. Imaging in juvenile idiopathic arthritis - international initiatives and ongoing work. Pediatr Radiol 2018; 48:828-834. [PMID: 29332166 PMCID: PMC5953998 DOI: 10.1007/s00247-017-4054-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/14/2017] [Accepted: 12/05/2017] [Indexed: 12/17/2022]
Abstract
Imaging is increasingly being integrated into clinical practice to improve diagnosis, disease control and outcome in children with juvenile idiopathic arthritis. Over the last decades several international groups have been launched to standardize and validate different imaging techniques. To enhance transparency and facilitate collaboration, we present an overview of ongoing initiatives.
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Affiliation(s)
- Charlotte M. Nusman
- Department of Pediatric Hematology, Rheumatology, Immunology and Infectious Disease, Emma Children’s Hospital, Academic Medical Center, 1100 Amsterdam, the Netherlands ,Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | | | - Robert Hemke
- Department of Pediatric Hematology, Rheumatology, Immunology and Infectious Disease, Emma Children’s Hospital, Academic Medical Center, 1100 Amsterdam, the Netherlands ,Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | - E. Charlotte van Gulik
- Department of Pediatric Hematology, Rheumatology, Immunology and Infectious Disease, Emma Children’s Hospital, Academic Medical Center, 1100 Amsterdam, the Netherlands ,Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Clara Malattia
- Pediatria 2- Reumatologia Istituto Giannina Gaslini, Genova and Department of Pediatrics, University of Genova, Genova, Italy
| | - Derk Avenarius
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Paolo Toma
- Department of Imaging, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Johannes Roth
- Division of Pediatric Rheumatology, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | | | - Mario Maas
- Department of Radiology, Academic Medical Center, 1100 Amsterdam, the Netherlands
| | | | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway ,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
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17
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Abstract
In juvenile idiopathic arthritis (JIA), imaging is increasingly used in clinical practice. In this paper we discuss imaging of the knee, the clinically most commonly affected joint in JIA. In the last decade, a number of important steps have been made in the development of imaging outcome measures in children with JIA knee involvement. Ultrasound is undergoing a fast validation process, which should be accomplished within the next few years. The validation processes of MRI as an imaging biomarker for clinical trials in the JIA knee are at an advanced stage, with important data available on the feasibility, reliability and validity of the Juvenile Arthritis MRI Scoring system. Moreover, both US and MRI data are emerging on the normal appearance of the growing knee joint.
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